Provider Demographics
NPI:1265500185
Name:PENN FOUNDATION INC
Entity Type:Organization
Organization Name:PENN FOUNDATION INC
Other - Org Name:ASSERTIVE COMMUNITY TREATMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUGRAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:215-257-6551
Mailing Address - Street 1:807 LAWN AVENUE
Mailing Address - Street 2:PO BOX 32
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-257-6551
Mailing Address - Fax:215-257-9347
Practice Address - Street 1:SUNNYBROOK VILLAGE
Practice Address - Street 2:500 CREEKSIDE DRIVE
Practice Address - City:SUITE 507
Practice Address - State:PA
Practice Address - Zip Code:19464
Practice Address - Country:US
Practice Address - Phone:610-819-6000
Practice Address - Fax:610-819-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA129323OtherHEALTH CHOICES
PAPE113171Medicaid
PAPE113171Medicaid